Giving Attention: Stories from the 4th Year of Medical School

Peter Gunderman, Masters of Theological Studies, Student, Indiana University School of Medicine

In reflecting on the importance of attention, twentieth century theologian and mystic Simone Weil wrote, “Those who are unhappy have no need for anything in this world but people capable of giving them their attention.” In contrast to Weil’s deeply religious understanding of attention, focused on human narratives, contemporary education often directs the medical student’s attention to clinical data and the requirements of the electronic medical record.

In many medical schools across the country, the later years of training are dedicated to patient care and clinical practice. In contrast to the “pre-clinical” years, during which students spend most days in lecture halls and study rooms, the clinical years are spent in hospitals, clinics, and patient rooms. This bipartite model of medical education is based on the presumption that medical students must have a sturdy foundation of knowledge before being involved in patient care.

Unfortunately, one of the shortcomings of this model is that medical students are often already formed in particular practices and conceptions of medicine before even interacting with patients. Based on their pre-clinical training, students often come to see their roles in clinical practice as information gatherers, reporters, test-takers, or perhaps, even as the infamous “gunner,” whose purpose lies in outperforming his/her classmates at every opportunity. Monthly exams, clinical performance scales, and preceptor evaluations reinforce these self-identified roles and their associated practices.

While such roles may have their own redeeming qualities and in certain ways are necessary aspects of medical education, a problem emerges when these lesser roles dominate medical practice to the neglect of more significant aspects of medicine.

One of the more important, even essential, purposes of medicine is to give attention to human suffering. In some cases—such as a dying patient—attention is all we can give, but even when the most aggressive and medically complex treatments are being pursued, attention is vital to patient care.

To truly attend to a patient is a difficult task, and medical students face multiple barriers in attempting to do so. Between reviewing the electronic medical record, checking on daily labs and imaging, writing notes, and studying for exams, students may spend only a few minutes seeing each patient.

The purpose of the stories to be presented is to illustrate the immense value in giving one’s attention but also to illustrate barriers to fully attending. Drawing from such varied experiences as tending to a gangrenous foot in the emergency department, draining an ENT patient’s abscess, taking time each day to talk with a schizophrenic patient, and telling these stories on rounds and in daily notes, we find that attention is, in the words of Simone Weil, “the rarest and purest form of generosity.”